| Payment ID | 108826 |
|---|---|
| Date Created | 05/30/25 12:17 pm |
| Created By | Gloria Jimenez |
| Service Request | 108576 |
| Application ID | 7884 |
| Authorization Number | 226123 |
| Applicant Information | |
| Name | Alexis Henry |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16170700637 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Type of Service Request | Hotel Stay |
| Location | Super 8 Waco University Area |
| Location Contact Name | Crystal |
| Location Email Address | Email hidden; Javascript is required. |
| Start Day | Monday |
| Guests | 3 |
| From | 05/29/2025 |
| To | 05/31/2025 |
| Days | 3 |
| Payment Details | |
| Payment Amount | $300.00 |
| Receipt Amount | $142.86 |
| Receipt Date | 05/29/2025 |
| Comments | partial week due to month end |
| Receipt | |
| Staff Name | Gloria Jimenez |
| Case Manager | LRE |
| Case Worker Email | Email hidden; Javascript is required. |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 05/30/2025 |
